Weight gain, excessive

Weight gain occurs when ingested calories exceed body requirements for energy, causing increased adipose tissue storage. It can also occur when fluid retention causes edema. When weight gain results from overeating, emotional factors — most commonly anxiety, guilt, and depression — and social factors may be the primary causes.

Among elderly people, weight gain commonly reflects a sustained food intake in the presence of the normal, progressive fall in basal metabolic rate. Among women, a progressive weight gain occurs with pregnancy, whereas a periodic weight gain usually occurs with menstruation.

Weight gain, a primary sign of many endocrine disorders, also occurs with conditions that limit activity, especially cardiovascular and pulmonary disorders. It can also result from drug therapy that increases appetite or causes fluid retention or from cardiovascular, hepatic, and renal disorders that cause edema.

History

Determine your patient’s previous patterns of weight gain and loss. Does he have a family history of obesity, thyroid disease, or diabetes mellitus? Assess his eating and activity patterns. Has his appetite increased? Does he exercise regularly or at all? Next, ask about associated symptoms. Has he experienced vision disturbances, hoarseness, paresthesia, or increased urination and thirst? Has he become impotent? If the patient is female, has she had menstrual irregularities or experienced weight gain during menstruation?

Form an impression of the patient’s mental status. Is he anxious or depressed? Does he respond slowly? Is his memory poor? What medications is he using?

CULTURAL CUE:Body weight is influenced by gender and race. For example, Black men tend to weigh less than White men and Black women tend to weigh more than White women of the same age. Socioeconomic status also affects weight gain. Individuals of lower socioeconomic status tend to have more pronounced obesity than those of middle-class or upper middle-class status.

Physical assessment

During your physical assessment, measure skin-fold thickness to estimate fat reserves. (See Evaluating nutritional status, pages 710 and 711.) Note fat distribution and the presence of localized or generalized edema and overall nutritional status. Inspect for other abnormalities, such as abnormal body hair distribution or hair loss and dry skin. Take and record the patient’s vital signs.

Medical causes

Acromegaly

Acromegaly causes moderate weight gain. Other findings include coarsened facial features, prognathism, enlarged hands and feet, increased sweating, oily skin, deep voice, back and joint pain, lethargy, sleepiness, and heat intolerance. Occasionally, hirsutism may occur.

Diabetes mellitus

The increased appetite associated with diabetes mellitus may lead to weight gain, although weight loss sometimes occurs instead. Other findings include fatigue, polydipsia, polyuria, nocturia, weakness, polyphagia, and somnolence.

Heart failure

Despite anorexia, weight gain may result from edema. Other typical findings in heart failure include paroxysmal nocturnal dyspnea, tachypnea, tachycardia, nausea, orthopnea, and fatigue.

Hypercortisolism

Excessive weight gain, usually over the trunk and the back of the neck (buffalo hump), characteristically occurs in hypercortisolism. Other cushingoid features include slender extremities, moon face, weakness, purple striae, emotional lability, and increased susceptibility to infection. Gynecomastia may occur in men; hirsutism, acne, and menstrual irregularities may occur in women.

Hyperinsulinism

Hyperinsulinism increases appetite, leading to weight gain. Emotional lability, indigestion, weakness, diaphoresis, tachycardia, vision disturbances, and syncope also occur.

Hypogonadism

Weight gain is common in hypogonadism. Prepubertal hypogonadism causes eunuchoid body proportions with relatively sparse facial and body hair and a high-pitched voice. Postpubertal hypogonadism causes loss of libido, impotence, and infertility.

Hypothyroidism

With hypothyroidism, weight gain occurs despite anorexia. Related signs and symptoms include fatigue; cold intolerance; constipation; menorrhagia; slowed intellectual and motor activity; dry, pale, cool skin; dry, sparse hair; and thick, brittle nails. Myalgia, hoarseness, hypoactive deep tendon reflexes, bradycardia, and abdominal distention may occur. Eventually, the face assumes a dull expression with periorbital edema.

Nephrotic syndrome

With nephrotic syndrome, weight gain results from edema. In severe cases, anasarca develops — increasing body weight up to 50%. Related effects include abdominal distention, orthostatic hypotension, and lethargy.

Pancreatic islet cell tumor

Pancreatic islet cell tumor causes excessive hunger, which leads to weight gain. Other findings include emotional lability, weakness, malaise, fatigue, restlessness, diaphoresis, palpitations, tachycardia, vision disturbances, and syncope.

Preeclampsia

With preeclampsia, rapid weight gain (exceeding the normal weight gain of pregnancy) may accompany nausea and vomiting, epigastric pain, elevated blood pressure, and visual blurring or double vision.

Other causes

Drugs

Corticosteroids, phenothiazines, and tricyclic antidepressants cause weight gain from fluid retention and increased appetite. Other drugs that can lead to weight gain include hormonal contraceptives, which cause fluid retention; cyproheptadine, which increases appetite; and lithium, which can induce hypothyroidism.

Special considerations

Psychological counseling may be necessary for patients with weight gain, particularly when it results from emotional problems or when uneven weight distribution alters body image. If the patient is obese or has a cardiopulmonary disorder, exercises should be monitored closely. Further studies to rule out possible secondary causes should include serum thyroid-stimulating hormone determination and dexamethasone suppression testing. Laboratory tests for serum cholesterol, triglyceride, and glucose levels should be performed because high levels of these substances are cardiac risk factors.

Pediatric pointers

Weight gain in children can result from an endocrine disorder, such as hypercortisolism. Other causes include inactivity caused by Prader-Willi syndrome, Down syndrome, Werdnig-Hoffmann disease, late stages of muscular dystrophy, and severe cerebral palsy.

Nonpathologic causes include poor eating habits, sedentary recreation, and emotional problems, especially among adolescents. Regardless of the cause, discourage fad diets and provide a balanced weight loss program. The incidence of obesity is increasing among children.

Geriatric pointers

Desired weights (weights associated with lowest mortality rates) increase with age.

Patient counseling

Educating the patient about weight control is extremely important. Stress the benefits of behavior modification and dietary compliance. Help the patient plan an appropriate exercise routine.

Pictures

Book Source Details

• Book Title: Signs & Symptoms: A 2-in-1 Reference for Nurses
• Author(s): Springhouse
• Year of Publication: 2007
• Copyright Details: Signs & Symptoms: A 2-in-1 Reference for Nurses, Copyright © 2007 Lippincott Williams & Wilkins.

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